Acute Myocardial Infarction Triggered by Coronary Artery Dissection and Heparin-Induced Thrombocytopenia: A Case Report

Nikath Nasreen N ¹, Kaavya M ¹, Logeswari B M ¹, Blessy John ^1*

This case showed the need for awareness of rare myocardial infarction causes, such as coronary artery dissection and heparin-induced thrombocytopenia, highlighting complex diagnostic and management challenges.

Abstract

Background: Myocardial infarction (MI) is typically associated with atherosclerosis, but rare etiologies like coronary artery dissection and heparin-induced thrombocytopenia (HIT) can also provoke MI. The simultaneous occurrence of these two conditions is exceedingly rare. This report presents the case of a 69-year-old woman who sustained blunt chest trauma from a motor vehicle accident and later developed MI due to both coronary artery dissection and HIT. Methods: The patient initially presented with chest trauma but was discharged after symptom resolution. Subsequently, she was re-admitted for unrelated symptoms and was administered subcutaneous heparin, leading to significant thrombocytopenia. Shortly after discharge, she presented with acute MI. Coronary angiography identified a spiral dissection with thrombosis in the right coronary artery, and laboratory tests confirmed HIT. Results: The patient underwent catheter-based thrombectomy and was treated with a direct thrombin inhibitor, followed by systemic anticoagulation with warfarin for three months. The patient recovered without further complications. Conclusion: This case represents the first documented instance of MI due to the combined effects of coronary artery dissection and HIT. It underscores the need for heightened awareness and prompt intervention in atypical MI presentations, especially in the context of recent trauma and heparin exposure. Multidisciplinary management was crucial in achieving a favorable outcome.

Keywords: myocardial infarction, coronary artery dissection, heparin-induced thrombocytopenia.

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